74例胰岛素瘤诊断和手术治疗方法的探讨

Diagnosis and Surgical Treatment of Pancreatic Ins ulinomas: A Re port of 74 Cases.

目的 :总结胰岛素瘤诊断和手术治疗的经验。方法 :对 1 966年 7月～ 2 0 0 1年 7月我院手术治疗、并有病理诊断的 74例胰岛素瘤病人进行回顾性研究。结果 :本组病人均符合Whipple三联征 ,至少有一次IRI G >0 .3。52 .70 %病人曾被误诊 ,仅 2 0 .2 7%病人在发病一年内得到正确诊断 ,平均病程 3 .36年。B超和EUS定位阳性率不高 ,CT和MRI正确检出率分别为 63.41 %和 63.64% ,ASVS正确检出率达 90 %。单发胰岛素瘤为 66例 (89.1 9% ) ,多发胰岛素瘤 2例 (2 .70 % ) ,增生 4例 (5 .41 % ) ,恶性胰岛素瘤 2例 (2 .70 % )。良性胰岛素瘤中 85 .2 7%直径≤ 2cm。单纯摘除是主要手术方法 ,88.52 %肿瘤切除后 30min血糖上升至正常水平以上 ,余于术后 2h内恢复至正常水平以上。 97.2 6 %的病人术后发生高血糖 ,一般在术后一周血糖恢复正常。最常见的术后并发症为胰瘘 (2 7.2 7% )和胰腺炎 (5 .1 9% )。结论 :胰岛素瘤是最常见的胰腺内分泌肿瘤。CT可作为首选的定位方法 ,对其他方法难以发现的肿瘤可行ASVS。手术是治愈胰岛素瘤的主要方法 。

To summarize the author' s experience in d iagnosis and surgical treatment of insulinoma. Methods : Seventy -four patients operated upon during the period from July 1966 to July 2001 and confirmed by pathologic examination were studied. There were 37 males and 37 fem ales, with an average age of 41.91 years. Results: All the pati ents had typical Whipple's triad with at least one test for IRI/G>0.3. Thirty-n ine patients (52.70%) were once misdiagnosed. Only 15 patie nts (20.27%) were dia gnosed correctly within a year after the onset of symptoms . The average time of evolution was 3.36 years. CT and MRI were able t o localize the tumor(s) in 63.41% and 63.64% of the cases, while ASVS p resented a higher locali zation rate of 90%. There were 66 cases(89.19%) of sing le insulinoma, 2 cases(2. 70%) of multiple insulinomas, 4 cases(5.41%) of hyperp lasia and 2 cases(2.70%) o f malignant insulinoma. Most of the benign insulinoma s(85.27%) were less than 2 cm in diameter, simple enucleation was required only . In 88.52% of the patients, glycemia rose to above the normal level in 30 min after tumor excision, the oth ers within 2 hrs; 97.26% of the patients experienc ed temporary hyperglycemia and recovered one week after operation. The principa l post-operative complications were pancreatic fistula(27.27%) and pancreatitis (5.19%). Conclusions: Careful and rational examination will he lp to make early diagnosis of th e disease. CT is the method of choice for local ization and ASVS is often useful in localizing difficult cases. Operation remai ns the main method of treatment fo r insulinoma(s). Efforts should be made to av oid the postoperative occurrence of pancreatic fistulas.